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The association between the behavior rating inventory of executive functioning and cognitive testing in children diagnosed with a brain tumor

de Vries M, de Ruiter MA, Oostrom KJ, Schouten-Van Meeteren AYN, Maurice-Stam H, Oosterlaan J, et al.

Child Neuropsychol, 2018 08;24(6):844-858.
PMID: 28693404 DOI: 10.1080/09297049.2017.1350262

Pediatric brain tumor survivors (PBTS) suffer from cognitive late effects, such as deteriorating executive functioning (EF). We explored the suitability of the Behavior Rating Inventory of Executive Function (BRIEF) to screen for these late effects. We assessed the relationship between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher, and we explored the clinical utility. Eighty-two PBTS (8-18 years) were assessed with EF tasks measuring attention, cognitive flexibility, inhibition, visual-, and working memory (WM), and with the BRIEF-Parent and BRIEF-Teacher. Pearson's correlations between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher were calculated. The BRIEF-Parent related poorly to EF tasks (rs < .26, ps > .01), but of the BRIEF-Teacher the WM-scale, Monitor-scale, Behavioral-Regulation-Index, and Meta-cognition-Index, and Total-score (rs > .31, ps < .01) related significantly to some EF tasks. When controlling for age, only the WM scale and Total score related significantly to the attention task (ps < .01). The inhibit scales of the BRIEF-Parent and BRIEF-Teacher correlated significantly (r = .33, p < .01). Children with clinically elevated scores on BRIEF scales that correlated with EF tasks performed worse on all EF tasks (ds 0.56-1.23, ps < .05). The BRIEF-Teacher Total and Index scores might better screen general EF in PBTS than the BRIEF-Parent. However, the BRIEF-Teacher is also not specific enough to capture separate EFs. Solely relying on the BRIEF as a screening measure of EFs in BPTS is insufficient. Questionnaires and tasks give distinctive, valuable information.

Matched MeSH terms: Brain Neoplasms/diagnosis*; Brain Neoplasms/mortality; Brain Neoplasms/pathology
Fulltext Evaluation Study of Intraoperative Cytology Smear and Frozen Section of Glioma

Zulkarnain S, Yunus N, Kandasamy R, Zun AB, Mat Zin AA

Asian Pac J Cancer Prev, 2020 Oct 01;21(10):3085-3091.
PMID: 33112571 DOI: 10.31557/APJCP.2020.21.10.3085

OBJECTIVE: Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient's future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques.
METHODS: A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis.
RESULTS: The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05).
CONCLUSION: Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.

Matched MeSH terms: Brain Neoplasms/epidemiology; Brain Neoplasms/pathology*; Brain Neoplasms/surgery
Fulltext Use of bevacizumab as a single agent or in adjunct with traditional chemotherapy regimens in children with unresectable or progressive low-grade glioma

Zhukova N, Rajagopal R, Lam A, Coleman L, Shipman P, Walwyn T, et al.

Cancer Med, 2019 01;8(1):40-50.
PMID: 30569607 DOI: 10.1002/cam4.1799

In pediatric low-grade gliomas not amenable to complete resection, various chemotherapy regimens are the mainstream of treatment. An excellent overall survival of these patients makes justification of the intensification of chemotherapy difficult and calls for the development of new strategies. Bevacizumab, a humanized monoclonal antibody directed against Vascular endothelial growth factor (VEGF), has been successfully used in combination with irinotecan in a number of adult and pediatric studies and reports. Fifteen patients at median age of 7 years old (range 3 months to 15 years) were treated with bevacizumab in combination with conventional low-toxicity chemotherapy. The majority had chiasmatic/hypothalamic and midline tumors, seven had confirmed BRAF pathway alterations including neurofibromatosis type 1 (2). Fourteen patients had more than one progression and three had radiotherapy. No deaths were documented, PFS at 11 and 15 months was 71.5% ± 13.9% and 44.7% ± 17.6% respectively. At the end of follow-up 40% of patients has radiologically stable disease, three patients progressed shortly after completion of bevacizumab and two showed mixed response with progression of cystic component. Rapid visual improvement was seen in 6/8 patients, resolution of endocrine symptoms in 2/4 and motor function improvement in 4/6. No relation between histology or BRAF status and treatment response was observed. Treatment-limiting toxicities included grade 4 proteinuria (2) and hypertension (2) managed with cessation (1) and pausing of therapy plus antihypertensives (1). In conclusion, bevacizumab is well tolerated and appears most effective for rapid tumor control to preserve vision and improve morbidity.

Matched MeSH terms: Brain Neoplasms/drug therapy*
Fulltext LINAC based radiosurgery and radiotherapy for neurosurgical diseases: what have we learnt so far

Zamzuri I, Badrisyah I, Rahman GI, Pal HK, Muzaimi M, Jafri AM, et al.

Med J Malaysia, 2011 Oct;66(4):346-9.
PMID: 22299555 MyJurnal

Stereotactic radiosurgery uses a single fraction high dose radiation while stereotactic radiotherapy uses multifractionated lower dose focused radiation.

Matched MeSH terms: Brain Neoplasms/radiotherapy*; Brain Neoplasms/surgery*
Fulltext Polymodal therapy for high grade gliomas: a case report of favourable outcomes following intraoperative radiation therapy

Zamzuri I, Rahman GI, Muzaimi M, Jafri AM, Nik Ruzman NI, Lutfi YA, et al.

Med J Malaysia, 2012 Feb;67(1):121-2.
PMID: 22582564 MyJurnal

High grade gliomas, frequently with their infiltrative nature, often make the outcome from neurosurgical intervention alone unsatisfactory. It is recognized that adjuvant radiochemotherapy approaches offer an improved prognosis. For these reasons, we opted for surgical debulking, intraoperative radiation therapy (IORT) in combination with whole brain irradiation therapy and chemotherapy (temozolamide cycles) in the management of a 42 year-old lady with Glioblastoma Multiforme (GBM). Her troublesome symptoms improved after 3 months of this polymodal therapy and remained independently functional for more than two years.

Matched MeSH terms: Brain Neoplasms/therapy*
Fulltext Early Malaysian experience on the use of head and neck localizers in the precision radiotherapy of intra and extra cranial sites for first 28 cases

Zamzuri I, Idris NR, Mar W, Abdullah JM, Zakaria A, Biswal BM

Med J Malaysia, 2006 Dec;61(5):621-5.
PMID: 17623965 MyJurnal

Precision Radiotherapy at high doses require a fixed, referable target point. The frame system fulfills the required criteria by making the target point relocatable and fixed within a stereotactic space. Since December 2001, we have treated 28 central and peripheral nervous system lesions using either radiosurgery as a single high dose fraction or fractionated 3-dimensional conformal radiotherapy using a lower dose and a multi-leaf collimator. Various pathological lesions either benign or malignant were treated. Eighty six percent of our treated lesions showed growth restraint, preventing them from causing new symptoms with a median follow-up duration of 20.5 months. However, the true benefit from this technique would require a long-term follow-up to document the progress.

Matched MeSH terms: Brain Neoplasms/radiotherapy*
Fulltext Presence of allelic loss and PTEN mutations in malignant gliomas from Malay patients

Zainuddin N, Jaafar H, Isa MN, Abdullah JM

Med J Malaysia, 2004 Oct;59(4):468-79.
PMID: 15779579

Loss of heterozygosity (LOH) on several loci and mutations on PTEN tumor suppressor gene (10q23.3) occur frequently in sporadic gliomas. We have performed polymerase chain reaction (PCR)-LOH analysis using microsatellite markers and single-stranded conformational polymorphism (SSCP) analysis to determine the incidence of allelic losses on chromosome 10q, 9p, 17p and 13q and mutations of exons 5, 6 and 8 of the PTEN gene in malignant gliomas. Twelve of 23 (52.2%) malignant glioma cases showed allelic losses whereas 7 of 23, (30.4%) samples showed aberrant band patterns and mutations of the PTEN gene. Four of these cases showed LOH on 10q23 and mutations of the PTEN gene. The data on LOH indicated the involvement of different genes in gliomagenesis whereas mutations of the PTEN gene indicated the role of PTEN tumor suppressor gene in the progression of glioma in Malay population.

Matched MeSH terms: Brain Neoplasms/genetics*
Loss of heterozygosity on chromosomes 10q, 9p, 17p and 13q in malays with malignant glioma

Zainuddin N, Jaafart H, Isa MN, Abdullah JM

Neurol Res, 2004 Jan;26(1):88-92.
PMID: 14977064

Recent advances in neuro-oncology have revealed different pathways of molecular oncogenesis in malignant gliomas including loss of heterozygosity on chromosomal regions harboring tumor suppressor genes. In the present study, we performed polymerase chain reaction-loss of heterozygosity (PCR-LOH) analysis using microsatellite markers to identify loss of heterozygosity on chromosomes 10q, 9p, 17p and 13q in the Malays with malignant gliomas. Of 12 cases with allelic losses, seven (58.3%) cases showed LOH on chromosome 10q, three (25.0%) cases showed LOH on chromosome 9p, four (33.3%) cases showed LOH on chromosome 17p and two (16.7%) cases showed LOH on chromosome 13q. The cases include five (41.7%) cases of glioblastoma multiforme, three (25.0%) cases of anaplastic astrocytoma, three (25.0%) cases of anaplastic oligodendroglioma and one (8.3%) case of anaplastic ependymoma. Four cases showed loss of heterozygosity on more than one locus. Our findings showed that loss of heterozygosity on specific chromosomal regions contributes to the molecular pathway of glioma progression in Malay population. In addition, these data provide useful evidence of molecular genetic alterations of malignant glioma in South East Asian patients, particularly in the East Coast of Malaysia.

Matched MeSH terms: Brain Neoplasms/genetics*
Association of p53 tumor suppressor gene with paraclinical and clinical modalities of gliomas patients in Malaysia

Yusoff AA, Abdullah J, Abdullah MR, Mohd Ariff AR, Isa MN

Acta Neurochir (Wien), 2004 Jun;146(6):595-601.
PMID: 15168228

Alteration of the tumor suppressor gene p53 is considered to be a critical step in the development of human cancer. Changes in this gene have been detected in a wide range of human tumours, including gliomas. In glioma, the presence of p53 gene alterations has been associated with worse prognosis.

Matched MeSH terms: Brain Neoplasms/diagnosis; Brain Neoplasms/genetics*; Brain Neoplasms/surgery
Random walker with improved weighting function for interactive medical image segmentation

Yin LK, Rajeswari M

Biomed Mater Eng, 2014;24(6):3333-41.
PMID: 25227043 DOI: 10.3233/BME-141156

To segment an image using the random walks algorithm; users are often required to initialize the approximate locations of the objects and background in the image. Due to its segmenting model that is mainly reflected by the relationship among the neighborhood pixels and its boundary conditions, random walks algorithm has made itself sensitive to the inputs of the seeds. Instead of considering the relationship between the neighborhood pixels solely, an attempt has been made to modify the weighting function that accounts for the intensity changes between the neighborhood nodes. Local affiliation within the defined neighborhood region of the two nodes is taken into consideration by incorporating an extra penalty term into the weighting function. Besides that, to better segment images, particularly medical images with texture features, GLCM variance is incorporated into the weighting function through kernel density estimation (KDE). The probability density of each pixel belonging to the initialized seeds is estimated and integrated into the weighting function. To test the performance of the proposed weighting model, several medical images that mainly made up of 174-brain tumor images are experimented. These experiments establish that the proposed method produces better segmentation results than the original random walks.

Matched MeSH terms: Brain Neoplasms/pathology*
Utilisation of Diffusion Tensor Imaging in Intracranial Radiotherapy and Radiosurgery Planning for White Matter Dose Optimization: A Systematic Review

Yahya N, Manan HA

World Neurosurg, 2019 Oct;130:e188-e198.
PMID: 31326352 DOI: 10.1016/j.wneu.2019.06.027

BACKGROUND: Diffusion tensor imaging (DTI), which visualizes white matter tracts, can be integrated to optimize intracranial radiation therapy (RT) and radiosurgery (RS) treatment planning. This study aimed to systematically review the integration of DTI for dose optimization in terms of evidence of dose improvement, clinical parameter changes, and clinical outcome in RT/RS treatment planning.
METHODS: PubMed and Scopus electronic databases were searched based on the guidelines established by PRISMA to obtain studies investigating the integration of DTI in intracranial RT/RS treatment planning. References and citations from Google Scholar were also extracted. Eligible studies were extracted for information on changes in dose distribution, treatment parameters, and outcome after DTI integration.
RESULTS: Eighteen studies were selected for inclusion with 406 patients (median study size, 19; range: 2-144). Dose distribution, with or without DTI integration, described changes of treatment parameters, and the reported outcome of treatment were compared in 12, 7, and 10 studies, respectively. Dose distributions after DTI integration improved in all studies. Delivery time or monitor unit was higher after integration. In studies with long-term follow-up (median, >12 months), neurologic deficits were significantly fewer in patients with DTI integration.
CONCLUSIONS: Integrating DTI into RT/RS treatment planning improved dose distribution, with higher treatment delivery time or monitor unit as a potential drawback. Fewer neurologic deficits were found with DTI integration.

Matched MeSH terms: Brain Neoplasms/radiotherapy
Neurocognitive impairment following proton therapy for paediatric brain tumour: a systematic review of post-therapy assessments

Yahya N, Manan HA

Support Care Cancer, 2021 Jun;29(6):3035-3047.
PMID: 33040284 DOI: 10.1007/s00520-020-05808-z

BACKGROUND: Proton therapy (PT), frequently utilised to treat paediatric brain tumour (PBT) patients, eliminates exit dose and minimises dose to healthy tissues that theoretically can mitigate treatment-related effects including cognitive deficits. As clinical outcome data are emerging, we aimed to systematically review current evidence of cognitive changes following PT of PBT.
MATERIALS AND METHODS: We searched PubMed and Scopus electronic databases to identify eligible reports on cognitive changes following PT of PBT according to PRISMA guidelines. Reports were extracted for information on demographics and cognitive outcomes. Then, they were systematically reviewed based on three themes: (1) comparison with photon therapy, (2) comparison with baseline cognitive measures, to population normative mean or radiotherapy-naïve PBT patients and (3) effects of dose distribution to cognition.
RESULTS: Thirteen reports (median size (range): 70 (12-144)) were included. Four reports compared the cognitive outcome between PBT patients treated with proton to photon therapy and nine compared with baseline/normative mean/radiotherapy naïve from which two reported the effects of dose distribution. Reports found significantly poorer cognitive outcome among patients treated with photon therapy compared with proton therapy especially in general cognition and working memory. Craniospinal irradiation (CSI) was consistently associated with poorer cognitive outcome while focal therapy was associated with minor cognitive change/difference. In limited reports available, higher doses to the hippocampus and temporal lobes were implicated to larger cognitive change.
CONCLUSION: Available evidence suggests that PT causes less cognitive deficits compared with photon therapy. Children who underwent focal therapy with proton were consistently shown to have low risk of cognitive deficit suggesting the need for future studies to separate them from CSI. Evidence on the effect of dose distribution to cognition in PT is yet to mature.

Matched MeSH terms: Brain Neoplasms
Fulltext Association of ERCC1 C8092A and ERCC2 Lys751Gln polymorphisms with the risk of glioma: a meta-analysis

Xin Y, Hao S, Lu J, Wang Q, Zhang L

PLoS One, 2014;9(4):e95966.
PMID: 24763305 DOI: 10.1371/journal.pone.0095966

To comprehensively evaluate the association of ERCC1 C8092A and ERCC2 Lys751Gln polymorphisms with the risk of glioma.

Matched MeSH terms: Brain Neoplasms/ethnology; Brain Neoplasms/genetics*
Relationships between PTEN gene mutations and prognosis in glioma: a meta-analysis

Xiao WZ, Han DH, Wang F, Wang YQ, Zhu YH, Wu YF, et al.

Tumour Biol., 2014 Jul;35(7):6687-93.
PMID: 24705863 DOI: 10.1007/s13277-014-1885-1

We conducted a meta-analysis in order to investigate the relationships between PTEN gene mutations and the prognosis in glioma. The following electronic databases were searched for relevant articles without any language restrictions: Web of Science (1945 ~ 2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966 ~ 2013), EMBASE (1980 ~ 2013), CINAHL (1982 ~ 2013), and the Chinese Biomedical Database (CBM) (1982 ~ 2013). Meta-analyses were conducted using the STATA software (Version 12.0, Stata Corporation, College Station, Texas USA). Hazard ratio (HR) with its corresponding 95 % confidence interval (95%CI) was calculated. Six independent cohort studies with a total of 357 glioma patients met our inclusion criteria. Our meta-analysis results indicated that glioma patients with PTEN gene mutations exhibited a significantly shorter overall survival (OS) than those without PTEN gene mutations (HR = 3.66, 95%CI = 2.02 ~ 5.30, P < 0.001). Ethnicity-stratified subgroup analysis demonstrated that PTEN gene mutations were closely linked to poor prognosis in glioma among Americans (HR = 3.72, 95%CI = 1.72 ~ 5.73, P < 0.001), while similar correlations were not observed among populations in Sweden, Italy, and Malaysia (all P > 0.05). Our meta-analysis provides direct and strong evidences for the speculation of PTEN gene mutations' correlation with poor prognosis of glioma patients.

Matched MeSH terms: Brain Neoplasms/genetics*; Brain Neoplasms/pathology
Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma

Wong TH, Amir Hassan SZ

Med J Malaysia, 2015 Dec;70(6):356-7.
PMID: 26988209

This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Matched MeSH terms: Brain Neoplasms
Fulltext Meningioma--the Sarawak General Hospital experience

Wong SH, Chan SH

Med J Malaysia, 2002 Dec;57(4):467-73.
PMID: 12733172

The aim of this study was to determine the factors for the large size of intracranial meningiomas at the time of presentation to the Sarawak General Hospital. The data was collected prospectively from 1/3/2000 to 28/2/2001. During this period a total of 57 cases of intracranial tumours were operated upon. Twenty of these cases (35%) were meningioma, making meningioma the most common intracranial tumour operated in the Neurosurgery service here with one to two cases operated per month. Headache was the most common symptom. The average duration of symptoms before the diagnosis was made was twenty-five months, the longest being fifteen years. The patients needed an average of seven visits prior to the diagnosis.

Matched MeSH terms: Brain Neoplasms/diagnosis; Brain Neoplasms/epidemiology*; Brain Neoplasms/therapy
Fulltext Anticancer Mechanism of Curcumin on Human Glioblastoma

Wong SC, Kamarudin MNA, Naidu R

Nutrients, 2021 Mar 16;13(3).
PMID: 33809462 DOI: 10.3390/nu13030950

Glioblastoma (GBM) is the most malignant brain tumor and accounts for most adult brain tumors. Current available treatment options for GBM are multimodal, which include surgical resection, radiation, and chemotherapy. Despite the significant advances in diagnostic and therapeutic approaches, GBM remains largely resistant to treatment, with a poor median survival rate between 12 and 18 months. With increasing drug resistance, the introduction of phytochemicals into current GBM treatment has become a potential strategy to combat GBM. Phytochemicals possess multifarious bioactivities with multitarget sites and comparatively marginal toxicity. Among them, curcumin is the most studied compound described as a potential anticancer agent due to its multi-targeted signaling/molecular pathways properties. Curcumin possesses the ability to modulate the core pathways involved in GBM cell proliferation, apoptosis, cell cycle arrest, autophagy, paraptosis, oxidative stress, and tumor cell motility. This review discusses curcumin's anticancer mechanism through modulation of Rb, p53, MAPK, P13K/Akt, JAK/STAT, Shh, and NF-κB pathways, which are commonly involved and dysregulated in preclinical and clinical GBM models. In addition, limitation issues such as bioavailability, pharmacokinetics perspectives strategies, and clinical trials were discussed.

Matched MeSH terms: Brain Neoplasms/drug therapy*
Fulltext Germinoma of the basal ganglia and thalamus--CT and MRI findings

Wong LW, Jayakumar CR

Singapore Med J, 1997 Oct;38(10):444-6.
PMID: 9529959

A case of germinoma originating in the basal ganglia and thalamus is presented. This tumour most commonly originates during childhood and adolescence, at pineal and suprasellar regions. In the early stages, the diagnosis of germinoma in the basal ganglion and thalamus is difficult because of its rarity and non-specific findings. The computed tomography (CT) and magnetic resonance imaging (MRI) findings though non-diagnostic, are discussed here. A few differential diagnoses had been discussed with radiological abnormality. Open biopsy done in this case proved to be two-cell pattern germinoma. Early detection of the tumour is desirable, since this tumour is highly sensitive to radio and chemotherapy and is potentially curable. Our patient was treated with combined chemotherapy and the response was well and no residual tumour or recurrence was seen on the repeated imaging modality, however his neurological deficits remained unchanged.

Matched MeSH terms: Brain Neoplasms/diagnosis*; Brain Neoplasms/radiography
Fulltext Intracranial germinoma metastasizing via a ventriculo-peritoneal shunt

Wong KT, Koh KB, Lee SH, Chee CP

Singapore Med J, 1996 Aug;37(4):441-2.
PMID: 8993152

Primary germinomas of the central nervous system carry a good prognosis because of their radiosensitivity. Recurrences are rare and extraneural metastases are even more unusual. One of the possible routes of extraneural spread is via ventriculo-peritoneal shunts which may be required to reduce intracranial pressure. One such case of germinoma metastasizing via a ventriculo-peritoneal shunt is reported. Patients with intracranial germinomas and ventriculo-peritoneal shunts should have close surveillance of their abdomens and may require systemic chemotherapy.

Matched MeSH terms: Brain Neoplasms/diagnosis; Brain Neoplasms/pathology*; Brain Neoplasms/radiotherapy
Fulltext Brain herniation in a neonate

Wong CY, Azizi AB, Shareena I, Rohana J, Boo NY, Isa MR

Singapore Med J, 2010 Oct;51(10):e166-8.
PMID: 21103805

Brain herniation is generally thought to be unlikely to occur in newborns due to the presence of the patent fontanelles and cranial sutures. A review of the literature published from 1993 to 2008 via MEDLINE search revealed no reports on neonatal brain herniation from intracranial tumour. We report a preterm Malay male infant born via elective Caesarean section for antenatally diagnosed intracerebral tumour, which subsequently developed herniation. Cerebral magnetic resonance imaging showed features that were compatible with a large complex intracranial tumour causing mass effect and gross hydrocephalus. Tumour excision was scheduled when the infant was two weeks old. Unfortunately, on the morning of the surgery, he developed signs of brain herniation and had profuse tumour haemorrhage during the attempted excision. Histopathological examination revealed an embryonal tumour, possibly an atypical rhabdoid/teratoid tumour. This case illustrates that intracranial tumours in newborns can herniate and should therefore be closely monitored.

Matched MeSH terms: Brain Neoplasms/pathology

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